Provider Demographics
NPI:1528061652
Name:HARRIS, ROBERT C (MD,)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 E 51ST ST
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3610
Mailing Address - Country:US
Mailing Address - Phone:918-665-6799
Mailing Address - Fax:
Practice Address - Street 1:3820 E 51ST ST
Practice Address - Street 2:STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3610
Practice Address - Country:US
Practice Address - Phone:918-665-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-09-19
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
OK15903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100074060AMedicaid
OK100074060AMedicaid